When management goes wrong (and right).

Time and again we see it. Health care managers want to dramatically improve the performance of their organization, so they go looking. Unfortunately they often go looking in the wrong places. They go looking for a training program, scheduling software, a provincial assessment tool, or a new way to motivate employees. For consultants, there is great money to be made in helping organizations with these tools. What is missing, and why does this search so often end in disappointing results? Why don’t we regularly see improvements in the range of 20-30% over a period of weeks? The answer is a challenge to conventional management.

Under-performance in healthcare is a story about management focus. Today, managers know a lot about:

The problem is, these activities don’t lead to fundamental and dramatic performance improvement. Feel free to challenge me on this, but in my experience, most managers readily agree. They are perceived as required, often by the funder or other stakeholder, and they are always time consuming. A scarcity of management resources means efforts to control and improve how care is delivered don’t get addressed. This causes frustration and a sense of resignation among managers.

As one small example, in my earlier management career I spent many hours administering the legalities and administrative procedures of effective competitive purchasing. Meanwhile, I would dread the staff meetings where the issues of service wait times were raised, repeatedly. These wait times were caused, in part, by the procurement approach itself. We had management time available for procurement, but not nearly enough for improving the service experience.

What great organizations like Toyota understand is that the transformation is in the nature of management itself, and the set of beliefs managers hold. They create a management approach concerned with how work is designed to deliver customer value. Transformed performance comes from changing the perspective of management from top-down to inside-out. In this approach, the customer is at the centre, pulling value from the organization.

For healthcare service delivery organizations, this means leadership gets a heartfelt understanding of what patients value. They know how patient demands present to the organization, and the capability of their organization’s processes to meet demand. They are regularly finding this out…directly.

We need to rebalance healthcare management’s focus away from deploying projects and rolling out activities conceived far from the ‘gemba’. This is hard. It sounds very intelligent to speak in board rooms of system planning, governance and funding, performance incentives, managing compliance or rolling out shared IT solutions. Conventional management, and management consulting, in health care are replete with people who can speak smartly in these areas. We think we need to find ways to shift management effort towards designing and implementing, alongside staff, systems of work that deliver value to patients.

Our greatest successes in consulting have been when we help organizations alter their management approach, while also working with them on improving care processes. We have refined a three pronged approach that resonates with managers and clinicians alike- identifying value, understanding reality, and taking action. The results are dramatic and often unexpected.

The trick is in not copying WHAT other organizations, like Toyota, do. (Unless we are building cars!) The goal is to transform management thinking so that we focus resources on the effective design of systems that meets patient demand, without fail. This will take unlearning some of our current management habits in health care.